Diagnostic yield and safety of medical thoracoscopic versus CT guided percutaneous tru-cut pleural biopsy

Abstract

Introduction: Pleural effusion is considered the most common presentation of pleural diseases; around 50% of cases of pleural effusion remain undiagnosed following thoracentesis. Purpose: To compare between the diagnostic accuracy, safety and complications of medical thoracoscopic (MT) versus CT guided (CTG) tru-cut pleural biopsy. Patients and Methods: The patients with unexplained exudative pleural effusion were classified into two groups for either MT or CTG tru-cut pleural biopsy. The pleural biopsies obtained during both procedures were sent for mycobacterial culture and histopathology. Results: Complications of MT were pain in 6 (20%), prolonged air leak in 2 (6.7%) and subcutaneous emphysema in 2 (6.7%) patients. While the complications of CT guided pleural biopsy were pain in 3 (10%) and pneumothorax in 2 (6.7%) patients with no significant difference. Length of hospital stay was 5.13 ± 1.63 in MT and 2.83 ± 1.23 in CTG group; the difference was highly significant (P Conclusions: Medical thoracoscopy and CT guided pleural biopsy are safe techniques with high diagnostic yield and low complication rate; However, MT was slightly more sensitive than CTG biopsy besides its therapeutic role. On the other hand, CT guided biopsy has a shorter hospital stay than thoracoscopic technique. Proper selection of the procedure will increase the diagnostic value of each procedure.